Nationwide survey for acute liver failure and late-onset hepatic failure in Japan
Nationwide survey for acute liver failure and late-onset hepatic failure in Japan
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DOI：
10.1007/s00535-017-1394-2
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发表时间：
2018-06-01
影响因子：
6.3
通讯作者：
Mochida, Satoshi
中科院分区：
文献类型：
--
作者：
Nakao, Masamitsu;Nakayama, Nobuaki;Mochida, Satoshi
背景 为了明确日本急性肝衰竭（ALF）和迟发性肝衰竭（LOHF）的现状，进行了一项全国性调查。方法每年在 782 家医院对符合日本诊断标准的 ALF 和 LOHF 患者进行两步调查。然后将患者的临床特征与之前调查中报告的患者进行比较。结果 2010 年至 2015 年间，共有 1554 名 ALF 和 49 名 LOHF 患者入组。受试者分为 1280 名肝炎患者（642 名非昏迷和 638 名昏迷）和 323 名非肝炎患者（190 名非昏迷和 133 名昏迷）。与 1998 年至 2009 年期间就诊的患者相比，观察到患者年龄较大，潜在肝外疾病的比例较高。尽管肝炎病毒感染是最常见的病因，但与之前的队列相比，患有该病因的患者百分比有所下降，而药物性肝损伤、自身免疫性肝炎和病因不明的患者百分比有所增加。 170 名患者（10.6%）接受了肝移植，而大多数昏迷患者接受了血浆置换和/或血液透析滤过的人工肝支持。昏迷患者的结局不佳，与以往的调查相似，特别是乙型肝炎病毒携带者，包括新发乙型肝炎患者（未经肝移植的存活率为5.4%）。 结论 尽管ALF和LOHF患者的临床特征（包括病因）发生了变化，但近年来患者的结局并没有改善。
Background A nationwide survey was performed to clarify the recent status of acute liver failure (ALF) and late-onset hepatic failure (LOHF) in Japan.Methods Two-step surveys for patients with ALF and LOHF meeting the Japanese diagnostic criteria were performed annually in 782 hospitals. The clinical features of the patients were then compared to those reported in previous surveys.Results In total, 1554 and 49 patients with ALF and LOHF, respectively, who were seen between 2010 and 2015 were enrolled. The subjects were classified into 1280 patients with hepatitis (642 non-comatose and 638 comatose) and 323 patients without hepatitis (190 non-comatose and 133 comatose). Compared with patients seen between 1998 and 2009, an older patient age and a higher percentage of underlying extrahepatic disease were observed. Although hepatitis virus infection was the most frequent etiology, the percentage of patients with this etiology had decreased, compared with previous cohorts, while the percentages of patients with drug-induced liver injuries, autoimmune hepatitis, and an indeterminate etiology had increased. Liver transplantation was performed in 170 patients (10.6%), whereas artificial liver support with plasmapheresis and/or hemodiafiltration were performed for most of the comatose patients. The outcomes of comatose patients were unfavorable, similar to previous surveys, especially the outcomes of hepatitis B virus carriers, including those with de novo hepatitis B (survival rate of 5.4% without liver transplantation).Conclusion Although the clinical features, including the etiologies, of patients with ALF and LOHF have changed, the outcomes of patients have not improved in recent years.